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T a Verification of Supervised Experience form (attached to this application) completed by each of your supervisors verifying completion of at least 2,000 hours of supervised substance use disorder counseling experience. The form must be completed in it s entirety by the DOPL-AP-139 Rev 2012-08-08 1 supervisor. If you completed a portion of your experience outside of Utah, submit documentation verifying your supervisor s license type and license number. 4. Submit an $85 check to c.

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